Abstract
Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke. Objective: To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke. Design: Retrospective cross-sectional design. Setting: Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation. Participants: Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007. Interventions: Not applicable. Main Outcome Measure: Discharge FIM rating and discharge setting (community vs institutional). Results: Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77). Conclusions: Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 345-350 |
| Number of pages | 6 |
| Journal | Archives of Physical Medicine and Rehabilitation |
| Volume | 91 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2010 |
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Keywords
- Outcome assessment (health care)
- Rehabilitation
ASJC Scopus subject areas
- Rehabilitation
- Physical Therapy, Sports Therapy and Rehabilitation
Cite this
Utility of Functional Status for Classifying Community Versus Institutional Discharges After Inpatient Rehabilitation for Stroke. / Reistetter, Timothy; Graham, James E.; Deutsch, Anne; Granger, Carl V.; Markello, Samuel; Ottenbacher, Kenneth.
In: Archives of Physical Medicine and Rehabilitation, Vol. 91, No. 3, 03.2010, p. 345-350.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Utility of Functional Status for Classifying Community Versus Institutional Discharges After Inpatient Rehabilitation for Stroke
AU - Reistetter, Timothy
AU - Graham, James E.
AU - Deutsch, Anne
AU - Granger, Carl V.
AU - Markello, Samuel
AU - Ottenbacher, Kenneth
PY - 2010/3
Y1 - 2010/3
N2 - Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke. Objective: To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke. Design: Retrospective cross-sectional design. Setting: Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation. Participants: Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007. Interventions: Not applicable. Main Outcome Measure: Discharge FIM rating and discharge setting (community vs institutional). Results: Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77). Conclusions: Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings.
AB - Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke. Objective: To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke. Design: Retrospective cross-sectional design. Setting: Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation. Participants: Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007. Interventions: Not applicable. Main Outcome Measure: Discharge FIM rating and discharge setting (community vs institutional). Results: Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77). Conclusions: Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings.
KW - Outcome assessment (health care)
KW - Rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=77949309102&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77949309102&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2009.11.010
DO - 10.1016/j.apmr.2009.11.010
M3 - Article
C2 - 20298822
AN - SCOPUS:77949309102
VL - 91
SP - 345
EP - 350
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
IS - 3
ER -